On Leaving a Policy Governance Board

As the time comes to move on, John Bruce, chair of the board of a major UK hospital for the past eleven years, reflects on his experience and his hopes and fears for the future of the board and hospital about which he cares so much. In particular, Board Leadership asked John, “What is it like to leave a Policy Governance board”?

By the time I came to chair the board of Southend University Hospital Foundation Trust (SUHFT) in the year 2000, I had already been a member of the board for six years. It is astounding to think that I have therefore been on the board for around seventeen years in total.

To become a nonexecutive board member (UK hospital boards include executive as well as nonexecutive members) and then chair involved going through an extensive appointments process, and my previous experience as chair of a college probably stood me in good stead.

My general aim at the college and at the hospital has been to make a difference by helping to ensure that the organization is doing an ever better job. However, when I first became a chair at the college, I couldn’t get any real answers about how what I was doing as a board member, and how a chair should contribute to that. I found myself just practicing what went before without any reason for doing so.

I then came across Policy Governance at a conference I attended in Toronto in 1993. Hearing John Carver’s presentation brought a level of clarity to the job of the board, the chair, and the chief executive that was quite new to me. Since then, I have tried to bring that clarity to my work, and eventually to my work at the hospital, which became my main preoccupation a few years after the Toronto conference.

In 2006 Southend Hospital became an NHS Foundation Trust and thereby gained greater freedom to run its own affairs, but it was clear that we as a board were going to need to take a much firmer grip because we were no longer protected by layers of performance management through the National Health Service (NHS). This provided the opening for the board to consider doing things differently, and my persistent attempts to bring Policy Governance principles to the hospital began to pay off.

Today I would say we have made some real progress. We are getting better at connecting with our owners (our members) and probably have a better connection than many other foundation trusts. We are better disciplined in the conduct of ourselves as a board and sticking to our governing job. We don’t just receive reports. We no longer spend our time approving things without criteria. What we do today is decided by the board, not the staff, and the difference between one meeting and another is more than just the date.

The biggest difference has probably come in our policy creation and monitoring process. The whole idea of prestated criteria, let alone comprehensive criteria, is unusual in our world, and this process has had the board creating expectations beyond what was previously required. The evolution of our monitoring process has also been enormous as we have adopted and improved practice over the past four or five years. Our board is very much a learning board and is seeing that what seemed reasonable at one point may not be six months later. In our old governance world, there was no comparison for this kind of rigor and understanding.

I have put far more time into my work at the hospital than I am required to because I am passionate about it. I want our community to get the full benefit of being able to exercise more ownership because we are a foundation trust, and I want to ensure that our governance practice is good. In my role at the hospital, I have in fact chaired two bodies: the board of directors (executives and nonexecutives), which governs the operation of the hospital, and the board that represents the hospital’s membership and appoints the nonexecutives. There is no doubt that I am going to miss it all, but it is long past time someone else took it on.

I am leaving feeling that the job of embedding good governance is not finished, but I also know it can probably never be. I hope that before I leave (which as I write is still four months away), we will have done more work on our Ends, which is probably the area that we have least developed as a board and yet represents our biggest opportunity. I believe we can create far greater cultural and operational alignment among our ownership, our board, and our organization than has ever been possible in the past.

The key difference for me in leaving a board on the Policy Governance journey is that I am leaving the hospital board as much more of a leadership body than the one I joined eleven years ago. In other words, I am leaving a body that is much clearer about the need to work with its owners to determine its own role and destiny rather than being entirely at the mercy of the changing regulatory winds and its executive’s support.

I am also leaving a board that has a far greater body of corporate memory than it would otherwise have. Through its policy creation, the board’s codification of its expectations of itself and the organization is reasonably solid. As a result, I believe the transition to my successor, and from any board member to another, will be a lot smoother than it might have been.

I cannot help but be anxious about whether the board will continue to build on the progress we have made. It is a bit unnerving when you hear a candidate for the job of chair asking, “Who looks after the governance of the hospital?” And the fact is that this is a very intense industry, so it is a constant struggle to secure enough time on the agenda for governance education and system maintenance issues.

The three main things I believe will most serve the board in the future are: continuing work on the board’s ensuring that operations are productive of Ends through monitoring, continued development of our relationship with our owners, and being prepared to spend time on governance rather than governing.

I have been asked what I would most like people to say about me as I move on, and I suppose it is that I showed that I cared that the board should do a good job. It has been a great privilege, scary, exhilarating, and with lots of lights going on—though not necessarily all at the same time!